Top Five Things You Need to Know Before Filing an ERISA Long Term Disability Claim Appeal

  1. Time is not on your side. There are strict deadlines and regulations, which MUST be adhered to, or a claimant may risk losing the ability to pursue the claim in court. Forever. And the clock starts ticking when your claim is denied. There have been many unsuccessful lawsuits because appeals were denied based on the expiration of the time limit. Claimants do not always succeed. Do not delay calling an experienced long-term disability attorney to review your denial letter and discuss your options.
  2. You are entitled to the file that the insurance company maintains on your claim. Getting it is not always easy - and remember, the clock is ticking on your appeal. Preparing a strong appeal requires having those materials for two reasons: to prepare your appeal, and to prepare for the possibility of litigation if the appeal is denied. Our office requests and obtains claimant's files on a routine basis, but that is because we are familiar with the system and the pitfalls. There is often good information within the file, so securing the materials is crucial.
  3. You should review the denial decision reasoning and rebut each and every reason utilized as the foundation for the claim decision. No argument can be left unmade. Unless you are an experienced disability attorney, you may not be able to go one-for-one with the insurance company. Frankel & Newfield has represented attorneys -even insurance attorneys -who thought they would be able to develop this research, but failed. This is one battle you don't want to take on yourself.
  4. Your rebuttal evidence can and should include medical and vocational evidence, diagnostic testing where applicable, factual support from affidavits and support statements, and a pointed factual rebuttal, as well as supported by medical literature describing the condition(s) at issue. This appeal may have a second audience - a Federal Judge - if the appeal is unsuccessful, so ensure that the appeal keeps that in mind.
  5. If you do not restrict the scope of access you have provided to the insurance company, they will try to call your doctors during the appeal process, and potentially miscast a "peer to peer" discussion; thought should be given to requiring written contact only with claimant's doctors.

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While the insurance company will often try to rush you through this appeal review, it is imperative that you appreciate the significance of this aspect of the process. Before trying to handle an ERISA appeal on your own, call our office for a free evaluation of your situation at 877-LTD-CLAIM (877-583-2524) to learn how we can help.

Justin C Frankel

Written By:

Justin C. Frankel

Disability Insurance Attorney